Aintree Tinnitus Support Group • Registered with the BTA
The Terms of Reference of Aintree Tinnitus Support Group • To provide additional information and support to patients, and their significant others, living with tinnitus • It is not a substitute for an individual management plan and individual medical advice cannot be given at the meetings
Boundaries • Not a substitute for individual assessment • Unilateral, pulsatile and distressing tinnitus should be investigated • Respect confidentiality • Respect any shared experiences • Unable to answer specific questions
Aintree Tinnitus Support Group November 2017 Tinnitus treatments Kimberley Moss Senior Audiologist
Outline of today’s presentation • Current guidelines / therapy options • What is Evidence based practice? • Audiology practices across the UK • The future of tinnitus treatments
Current guidelines for tinnitus treatment In 2009 the Department of Health produced a good practice guide to improve people’s access to and experience of tinnitus services.
Evidence Based Practice Clinical Individual Best available experience Patient need Research
• Hearing aids • Information / directive counselling • Psychological therapies • Sound enrichment • Relaxation therapy • Sleep hygiene techniques
Hearing aids -First line of treatment for many patients. -In most cases tinnitus is associated with some degree of hearing loss and is most likely the result of hearing-loss related changes in the brain (Sereda et al., 2011; Sereda et al., 2015)
Hearing aids • Improve communication, which may reduce stress and anxiety often associated with tinnitus • enhance the loudness of everyday sounds which might reduce the loudness of the tinnitus. • Studies suggest for a significant number of people, hearing aids do reduce the effect of tinnitus. • Bilateral hearing aids have been shown to be more effective than using one aid. • Digital hearing aids have increased in beneficial effects of hearing aids for tinnitus • More research needed, especially for mild losses.
Aintree example 60 60 Average Tinnitus Functional Index scores Average scores on Newman Tinnitus Handicap Index before and after hearing aid fitting Before and after hearing aid fitting 50 50 40 40 30 30 20 20 10 10 0 0 TFI before TFI after NTHI before NTHI after
Combination devices • Hearing aid combined with a sound generator . Amplifies sounds, and provides extra low level sounds in order to try to help the habituation process Some research on a small number of patients but further work is required to single out the benefit from that given purely by amplification. “For most, amplification alone provided a reduction in tinnitus annoyance”. There is at present no proven advantage to using these devices rather than simple hearing aids.
Tinnitus maskers. • Provide low level sounds in order to try and help reduce tinnitus annoyance. • Cochrane review reported “no significant change ..in loudness..or overall severity of tinnitus compared to other interventions” • Some evidence to show sound therapy is more effective for patients with hyperacusis (hypersensitivity to sound) • Hearing aids are better if there is a hearing loss.
Environmental sound enrichment Introducing a sound into your environment that doesn’t demand too much attention, and isn't unpleasant to listen to Easiest and most practical thing you can do for yourself Environmental sound (having a window open) CD, mp3, smart phone app, bed side noise Generator Especially useful at night
Psychological Therapy
Psychological therapy The most extensively trialled intervention for tinnitus is Cognitive Behavioural Therapy (CBT) with most RCTs reporting significant improvement in tinnitus severity. - Aintree leading the way using Solution Focused Approach during consultations & therapy sessions. Psychology is embedded in our clinics with ongoing supervision and training from a clinical psychologist. - Published articles and presented to the BTA.
Relaxation Therapy Evidence shows relaxation techniques can be useful in tackling tinnitus intrusiveness, and depression. Mindfulness is a relaxation technique which involves sitting quietly and paying more attention to the present moment – to your own thoughts and feelings, and to the world around you . A recent study showed it to be effective in reducing tinnitus annoyance. • Physiological relaxation – • breathing exercises, • muscle relaxation exercises
Sleep Hygiene techniques • Utilising good sleep hygiene techniques can help reduce the distressing effect of losing sleep due to tinnitus .
American guidelines to tinnitus treatments RECOMMEND NO RECOMMENDATION Education / Counselling Acupuncture Hearing aids RECOMMEND AGAINST Cognitive Behavioural therapy Medicinal therapy OPTION Dietary supplements Sound therapy Transcranial magnetic stimuation STRONGLY RECOMMEND AGAINST Routine imaging
• Medications for tinnitus • No evidence for efficacy of antidepressants, anti convulsant, benzodiazepines,melatonin medications and side effects were a concern. • No evidence Gingko biloba. • AUT0063 trial stopped due to lack of efficacy.
• Why has clinical research so far failed to identify a cure? • In the past our understanding of how tinnitus arises was limited. • What do we know? • Tinnitus is a brain thing, and that hearing loss disrupts nerve cell activity in the auditory system. • What don’t we know? • Exactly how these changes arises. • Several candidate mechanisms, and we are coming closer to understanding where in the auditory system the changes take place.
How are we doing at Aintree? Study by Hoare et al in 2012, sent questionnaires to all Audiology and hearing therapy staff involved in tinnitus care in the UK. Essentially found variations in the services offered at different Audiology departments across the country. At Aintree, patients have access to all recommended forms of tinnitus treatment, as determined by an individual assessment of their needs. Plus support group for patients/ non patients with tinnitus and their significant others. Regarded as an example of good practice.
The future of tinnitus treatments? “The picture of the mechanisms that lead to the development of tinnitus has become much clearer. I thus expect that the puzzle of how tinnitus arises will be solved within the next decade, and that this will lead to true targeted tinnitus treatments” Dr Roland Schaette, lead of the tinnitus research programme at UCL.
References Hoare, D. Evidence Update on current tinnitus management approaches,. Presentation delivered at UCL Tinnitus and Hyperacusis masterclass, 2016. Hoare D et al (2011). Systematic review and meta – analyses of randomised control trials examining tinnitus management. Layrngoscope. 12 (17) 1555-1564 BTA Annual research review 2016 - http://www.tinnitus.org.uk/ATRR2016 http://journals.lww.com/thehearingjournal/fulltext/2014/12000/First_Evidence_Based_Tinnitus_Guideline_Shines.1.aspx http://www.hearing.nihr.ac.uk/research/quest-in-eliminating-tinnitus http://www.hearing.nihr.ac.uk/research/better-understanding-the-heterogeneity-of-tinnitus http://www.hearing.nihr.ac.uk/research/validating-a-new-questionnaire-measure-of-tinnitus-functioning-and-disability-in- the-UK http://www.hearing.nihr.ac.uk/research/the-efficacy-of-hearing-aid-provision-for-tinnitus http://www.tinnitus.org.uk/where-were-at-research-evidence-for-tinnitus-benefit http://www.tinnitus.org.uk/mindfulness-behavioural-cognitive-therapy-study
Thank you
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